When these nodules are large enough, they compress the urethral canal, causing partial obstruction of the urethral canal, thus interfering with normal urinary flow. This alteration is very common, especially in men over 40 years of age. In fact, with advancing age, the gland spontaneously tends to change its volume, due to hormonal variations and the action of numerous growth factors. In other words, benign prostatic hyperplasia accompanies the normal aging process .
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Unfortunately, the underlying causes are not yet known exactly, but it is now established that changes in the hormonal structure (andropause) are involved.
In fact, with advancing age, the gland spontaneously tends to change its consistency and volume in response to the imbalance between androgens and estrogens, in favor of the latter, and to the action of numerous growth factors.
In addition to age, the following can also predispose to prostatic hypertrophy:
- Familiarity;
- Other concomitant diseases, such as obesity, cardiovascular disease and diabetes;
- Physical inactivity.
In the long run, benign prostatic hyperplasia can cause anatomical obstruction of the urethra and create problems with correct urinary outflow, so much so that the subject must increase the pressure necessary to empty the bladder.
, which in most cases allows you to perceive a possible enlargement of the prostate. In some cases, this examination is not sufficient; in this case, a rectal ultrasonography can be performed to better distinguish the size of the prostate. Alternatively or in combination, tests can be performed that measure the serum concentration of the prostate specific antigen, to exclude the presence of malignant neoformations of the prostate .
at the level of the prostate and bladder neck. Essentially, they relax the prostate by facilitating the passage of urine into the urethra.
5-alpha-reductase inhibitors, such as finasteride and dutasteride, inhibit the volumetric growth of the prostate by suppressing androgen stimulation. In practice, they work by blocking the transformation of testosterone into its active form, dihydrotestosterone (DHT), which participates in the enlargement of the prostate.
The major problems of the use of drugs for the treatment of benign prostatic hypertrophy are related to the possible side effects. These include erectile deficits, retrograde ejaculation and gynecomastia for 5-alpha-reductase inhibitors, while hypotension, migraine, dizziness, headache and asthenia are common among users of alpha blockers. Another common problem is that the efficacy of these drugs tends to decrease with long-term use.
Surgery
When drug therapy is ineffective, surgery is used.
The most used technique is transurethral endoscopic resection or TURP, a reduction of the prostate performed by endoscopy, ie without incisions. Alternative techniques aim to destroy part of the glandular tissue without damaging what will remain in place. For this purpose, depending on the method used, laser rays, radio waves, microwaves or chemicals are concentrated directly inside the prostate. The suitability or otherwise of these alternative techniques is mainly influenced by the extent of prostatic hyperplasia; in general, the greater the degree of hyperplasia, the more invasive the surgery will be. For example, if the size of the prostate is excessive, it is necessary to proceed with an open surgery, called adenonectomy. "whole prostate adenoma via a" skin incision, trans-vesical or retropubic.
Continue reading: Prostatic Hypertrophy Definition, Symptoms, Causes and Treatment
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